Admission rates of ED patients with transient ischemic attack have increased since 2000

Abstract

ObjectiveA study published in December 2000 showed that 5% of patients presenting with transient ischemic attacks (TIAs) developed a stroke within 48 hours. This finding has been corroborated in several other studies. We hypothesize that, influenced by this, emergency department (ED) physicians have been more reluctant to discharge TIA patients resulting in an increase in the percentage of TIA patients admitted. MethodsThis is a retrospective cohort of consecutive ED visits. This study is conducted in 6 New Jersey EDs with annual ED visits from 25000 to 65000. Consecutive patients seen by ED physicians between January 1, 2000, and December 31, 2010, were included. We identified TIA visits using the International Classification of Diseases, Ninth Revision, code. We analyzed the admission rates for TIA testing for significant differences using the Student t test and calculated 95% confidence intervals. ResultsOf the 2622659 visits in the database, 8216 (0.3%) were for TIA. Females comprised 57%. There was a statistically significant increase in the annual admission rates for TIA patients from 2000 to 2010, from 70% to 91%, respectively (difference, 22%; 95% confidence interval, 18%-26% [P < .001]). Separate analysis by sex showed similar increased admission rates for females and males. ConclusionsWe found that the admission rate for TIAs increased significantly from 2001 to 2010. This change in physicians' practice may be due to the body of evidence that TIA patients have a significant short-term risk of stroke.